Is 3-4+ Liver Fibrosis a Contraindication to Heart Transplantation?
Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
Meeting: 2020 American Transplant Congress
Abstract number: C-286
Keywords: Heart/lung transplantation
Session Information
Session Name: Poster Session C: Heart and VADs: All Topics
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Chronic liver disease in patients awaiting heart transplant is seen in patients with biventricular heart failure. This is mostly due to congestive hepatopathy due to the failing right ventricle. Chronic liver disease is diagnosed by non-invasive imaging (ultrasound and CT) and by liver biopsy. Patients with cirrhosis on biopsy and/or non-invasive imaging are not candidates for heart transplant alone. It is not clear as to whether stage 3-4+ fibrosis is a contraindication to heart transplant alone.
*Methods: Between 2010 and 2018, we assessed 54 heart transplant patients with established liver disease who underwent heart transplantation. Patients were divided into those with imaging suggestive of fibrosis (n=28), liver biopsy consistent with stage 3-4+ fibrosis (n=14), and both imaging and biopsy suggestive of fibrosis (n=12). Patients with no evidence of fibrosis served as the control (n=694). Endpoints included 1-year survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, percutaneous coronary intervention/angioplasty, new congestive heart failure, pacemaker/implantable cardioverter-defibrillator placement, stroke), and freedom from rejection (any treated rejection (ATR), acute cellular rejection (ACR), antibody-mediated rejection (AMR)). The development of vasoplegia defined as requiring high-dose pressor (vasopressin, epinephrine, norepinephrine) support for >24h within 48h after heart transplant surgery was also assessed.
*Results: Among the three fibrosis groups compared to the control group, there was no significant difference in 1-year survival, freedom from CAV, freedom from NF-MACE, and freedom from all rejections. Furthermore, vasoplegia was seen in similar incidence in all groups.
*Conclusions: Evidence of fibrosis on imaging, biopsy, and/or both imaging and biopsy does not appear to impact post-transplant outcome and therefore should not be viewed as an exclusion for heart transplant alone. Larger numbers are needed to confirm these findings.
| Endpoints | Imaging suggestive of fibrosis (n=28) | Biopsy suggestive of stage 3-4+ fibrosis (n=14) | Both imaging and biopsy suggestive of fibrosis (n=12) | Control – No evidence of fibrosis (n=694) | P-value |
| 1-Year Survival | 89.3% | 85.7% | 83.3% | 90.8% | 0.675 |
| 1-Year Freedom from CAV | 96.4% | 92.9% | 91.7% | 94.8% | 0.882 |
| 1-Year Freedom from NF-MACE | 92.9% | 100.0% | 83.3% | 86.2% | 0.373 |
| 1-Year Freedom from ATR | 82.1% | 92.9% | 100.0% | 85.0% | 0.471 |
| 1-Year Freedom from ACR | 89.3% | 92.9% | 100.0% | 93.2% | 0.693 |
| 1-Year Freedom from AMR | 96.4% | 100.0% | 100.0% | 94.1% | 0.640 |
| Incidence of vasoplegia (n, %) | 10 (35.7%) | 4 (28.6%) | 5 (41.7%) | 177 (25.5%) | 0.390 |
To cite this abstract in AMA style:
Kittleson M, Patel J, Chang D, Kransdorf E, Geft D, Nishihara K, Shen A, May B, Czer L, Esmailian F, Kobashigawa JA. Is 3-4+ Liver Fibrosis a Contraindication to Heart Transplantation? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/is-3-4-liver-fibrosis-a-contraindication-to-heart-transplantation/. Accessed November 22, 2024.« Back to 2020 American Transplant Congress